Learners will be able to:
Classify a situation as a rapid response or a code
Assess the need for escalation of care & resources
Organize responding personnel
Middle-aged man, new tachycardia & BP 65/42.
Oxygenating 90% on 2L by nasal cannula
Disoriented, somnolent, and diaphoretic
What do you do?
ABCs
What help do you have?
What help do you need?
e.g. Charge RN to expedite transfer
e.g. Phlebotomy for labs
e.g. Respiratory Support
What do you need in this situation?
| U of U | IMED | VA | |
|---|---|---|---|
| RRT/MET | House Sup, IM Res, SICU RN, Pharm | IM, CICU RN, Nurse Sup, Pharm, RT, EKG, ABG, Lab | IM, MICU, CNO, RNs, RT Pharmacy (7a-7p) |
| Code Blue | add: Anesth, EMT, MICU res, Pharm | add: ICU attgs | add: ED |
| Numbers | Shock Team, Cath, Brain Attack, VAD: 1-2222 | Shock Team: Vocera TICU attg, Brain Attack: Operator/x33333 | Brain attack: Page Neuro Senior, Cath: Page Cardiology, Code: x6666 |
Elderly male who is hypoxemic immediately after a blood transfusion
RR 24, SpO2 82% on room air
Sick or not sick? Stable or Unstable? What else do you need?
Begins to tripod with accessory muscle use.
Placed on 100% fio2 via face mask
O2 remains in the upper 80s
How has the situation changed?
| Rapid Response | Code Blue |
| In 5 minutes, will this be a code? | Brain Attack |
•Airway •In Extremis |
•Focal Deficit |
| •RRT → Code early | •Call brain attack •Transfer after-hours at VA |
Anesthesia at head of bed preparing to intubate
Single compressor starting to tire
Pharmacist trying to hand epi to RN on far end of the room
How can we improve things?
Bed out from the wall (for airway)
Rotate bed (for compressor space)
Drop the bed for CPR
“Everyone clear out unless I’ve given you a role”
Situations where you need other people? Airway, Cath/Shock Team, Neuro
Is this rapid really a code? Can’t breathe, extremis
Room control: move the bed out, lower the bed, send people away